目的：所有主要的美国指南现在都认可45-49岁的平均风险结直肠癌（CRC）筛查。存在对内窥镜能力可能紧张的担忧，低风险的人可以自我选择进行筛查，腺瘤检出率的计算可能会被稀释。我们分析了45-49岁的CRC筛查批准前后的年龄特异性筛查结肠镜检查体积和病变检出率。
方法：我们比较了我们的医疗保健系统在第1期（2017年10月至2018年12月）的结肠镜检查体积和病变检出率，在准则第一次改变之前，与第2期(2019年1月至2021年8月)相比，新准则的时代。
结果：在45至49岁的人群中进行首次筛查结肠镜检查的比例从3.5％增加到11.6％（相对风险，3.36；95%CI，2.45-4.61）。第2期腺瘤检出率，晚期腺瘤，无柄锯齿状病变，晚期无柄锯齿状病变，每次结肠镜检查腺瘤，45至49岁人群的每次结肠镜检查病变非常相似(34.3%，6.3%,8.6%,2.9%,分别为0.58和0.69）和50至54岁的人（38.2%，5.8%,9.4%,3.0%,分别为0.63和0.76）在首次筛查时，对于60至64岁的重新筛查者(33.4%，6.1%,7.2%,2.3%,分别为0.61和0.70）。所有检测率,每次结肠镜检查腺瘤，每次结肠镜检查的病变从第1期到第2期增加(例如，整体腺瘤检出率35.1%vs42.6%；P<0.0001)，在45至49岁的人群中没有任何下降。
结论：在我们的医疗保健系统中，较低的CRC筛查开始年龄对不同年龄的结肠镜检查体积有一定影响,但不影响筛查结果.病变检出率,包括晚期腺瘤，在平均风险为45至49岁的人群中，首次筛查时的50至54岁的人群和重新筛查时的60至64岁的人群接近。需要进行国家监测以充分评估降低CRC筛查开始年龄的影响。
All major U.S.
guidelines now endorse average-risk colorectal cancer (CRC) screening at 45-49 years of age. Concerns exist that endoscopic capacity may be strained, that low-risk persons may self-select for screening, and that calculations of the adenoma detection rate may be diluted. We analyzed age-specific screening colonoscopy volumes and lesion detection rates before vs after the endorsement of CRC screening at 45-49 years of age.
We compared colonoscopy volumes and lesion detection rates in our healthcare system during period 1 (October 2017 to December 2018), before the first change in
guidelines, vs period 2 (January 2019 to August 2021), the era of new
guidelines.
The proportion of first-time screening colonoscopies performed in 45- to 49-year-olds increased from 3.5% to 11.6% (relative risk, 3.36; 95% CI, 2.45-4.61). The period 2 detection rates for adenoma, advanced adenoma, sessile serrated lesion, advanced sessile serrated lesion, adenomas per colonoscopy, and lesions per colonoscopy were very similar for 45- to 49-year-olds (34.3%, 6.3%, 8.6%, 2.9%, 0.58, and 0.69, respectively) and 50- to 54-year-olds (38.2%, 5.8%, 9.4%, 3.0%, 0.63, and 0.76, respectively) at first-time screening, and for 60- to 64-year-olds at rescreening (33.4%, 6.1%, 7.2%, 2.3%, 0.61, and 0.70, respectively). All detection rates, adenomas per colonoscopy, and lesions per colonoscopy increased from period 1 to period 2 (eg, overall adenoma detection rate 35.1% vs 42.6%; P < .0001), without any decreases among 45- to 49-year-olds.
In our healthcare system, a lower CRC screening initiation age has modestly affected colonoscopy volume by age without compromising screening yield. Lesion detection rates, including for advanced adenomas, in average-risk 45- to 49-year-olds approximate those in 50- to 54-year-olds at first-time screening and 60- to 64-year-olds at rescreening. National monitoring is needed to assess fully the impact of lowering the CRC screening initiation age.
